I know I'm getting old because I can't even get fired up for a thread like this....too much drama for me now, but just my speed even a few years ago.
For those arguing so passionately, there are no winners and losers of this debate. I'm certain you're spending more time reading your own post than your opponent's, and planning the next witty attack.
To the OP (@
dbeast, am I doing it right?): I recommend you take these questions to an advisor at your school, as they will be the most helpful. Reading your posts, it seems like general surgery is not a great fit, but I wouldn't make such a huge life choice based on the recommendations of an anonymous message board.
I believe that the 2011 ACGME rules have changed the game significantly. They have truncated the intern year, and taken power and autonomy out of the intern's hands. This was traditionally the year with the steepest learning curve, so some argue that the "basic" surgical skills are taking longer to learn now, spilling over into the PGY2 year. Responsibility is subsequently shifted upward, which reduces the intern's role in patient care, and distracts senior residents from the more complex aspects of training. Anecdotally, I don't see a big difference in interns while they are interns, but I have noticed that PGY-2s seem a little bit weaker, both in the OR and on the wards. The finished product has yet to be determined, so I guess we'll find out in 2016.
Balancing your home life and your work can be difficult as a resident, and it remains difficult as an attending. I may not be as histrionic as @
vhawk, but I don't necessarily disagree with his approach. He knows training has been compromised, and he wants to ensure that he's ready to go at the end of 5 years. Once you've finished training, and you're building a practice, availability is extremely important. You make yourself available 24 hours a day because: 1) You are obsessed with ensuring your patients have good outcomes, both for their benefit and for the benefit of your growing referral base, 2) You know that you can plan your day easier when you catch things as they occur, rather than absorbing all info at 8am the next day when you already have a full elective caseload, etc, and 3) You know that being unavailable, or saying "no," to your referring doctors can have a large impact on your practice....if you aren't available, they'll simply use someone else.
I am actually a big proponent of home call, but I'd like to associate it with an in-house backup. Residents don't check out when they leave, but instead take calls on their own patients at night, but if the problem cannot be handled over the phone, it is then passed on to the night float, who then assumes care for the remainder of the night. The residents at home are therefore not coming in, but they maintain continuity of care with less hand-offs. Night float is also not overwhelmed with cross-coverage, and can focus on late operations, consults, etc. I would love to discuss this more if there's interest, as I think it's the only way to make the 80 hour rule work without compromising care.
@
southernIM, I love the parachutes reference. I've attached the article so some of the younger folk can be let in on the joke.
Overall, I can relate to all sides of this thread's major argument. I believe that some of the "chest pounding displays of bravado" start to fade with time, but some of that self-sacrificing mentality is a part of normal coping mechanisms, and most of us have experienced feelings similar to vhawk at some point. Since we work so much harder than other specialties, and we have Rodney Dangerfield-levels of respect for this work, we have to convince ourselves that it is for the greater good, and we must believe that our resilience is snowflake-level.
Of course, 80 hours or 120 hours, it's ridiculous to assume the ride is similar between surgery and IM. Surgery residents work harder, for a longer period of time, at an increased pace. But, that's only 5 years of your life.....the next 30-40 years after that are a completely different discussion, but I hope it's not a spoiler that you don't get to turn your pager off very often....
